Rwanda has been very successful in bringing down infant mortality to 50 deaths per 1000 births in
2010. After 2005 in particular, reproductive health services have been improved in both accessibility
and quality by further developing a community based health system. Antenatal care and family
planning services have had positive effects in avoiding unwanted pregnancies and improving the
outcomes of intended pregnancies. So far relatively little attention has been devoted to the spacing of
births, yet an extra focus on spacing in the health programs could be both beneficial and feasible.
There are clear indications that both short and long birth intervals can lead to adverse outcomes in
terms of perinatal mortality and of maternal morbidity. More healthy intervals could contribute to less
pregnancy complications and better outcomes for the mother and the new born child. In Rwanda
longer intervals are preferred. However, 20% of the pregnancies were conceived within 24 months
after the last birth (RDHS 2010). Enabling women to space their pregnancies would help reduce the
proportion of short birth intervals.
Yet the evidence base for this type of intervention is still weak. A number of potential uncertainties
and flaws can be identified. Much of the research only considers the intervals between consecutive
births; pregnancies that do not end in a life birth go unobserved. This does not only lead to an
underestimation of short intervals but also ignores the emotional burden of miscarriages and the
effects of pregnancy disruption on the subsequent health and reproductive behavior. The evidence on
the duration of a healthy interval after a pregnancy disruption is inconclusive. Some studies indicate
that short intervals provide better outcomes with the next pregnancy while other show that it might be
wise to wait at least 12 months or even longer before becoming pregnant again. Although it has been
theorized that maternal morbidity is an important cause of perinatal mortality the effects of shorter
pregnancy intervals on maternal morbidity have hardly been investigated empirically. To further
complicate the issue, very long intervals (more than 60 months) also turn out to have adverse effects.
Birth spacing of more than 5 years occurs among 10% of all pregnancies in Rwanda.